The Pharmaceutical Journal
Vol 274 No 7341 p327
19 March 2005

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Clopidogrel should be standard therapy for acute MI

Cardiologists have predicted that guidelines and clinical practice will change following the results of two major trials of antiplatelet therapy in acute myocardial infaction.

Howard Swanton, consultant cardiologist at the Heart Hospital in London and former president of the British Cardiac Society, told The Journal that clopidogrel will become standard treatment for acute MI. He said: “The results of the CLARITY and COMMIT trials have provided clear evidence that clopidogrel added to aspirin in acute MI is safe and brings added benefit.”

The CLARITY trial results, published online last week in the New England Journal of Medicine and presented at the American College of Cardiology annual meeting in Orlando, Florida, showed that adding clopidogrel to aspirin reduced the odds of another occluded artery, a second heart attack or death by 36 per cent after a week of being admitted to hospital. The event rate was 15 per cent in the clopidogrel arm compared with 21.7 per cent in the placebo arm, representing an absolute risk reduction of 6.7 per cent. At 30 days, there was a 20 per cent reduction in the odds of the composite endpoint of death from cardiovascular causes, recurrent heart attack or need for urgent coronary revascularisation.

The rate of major bleeding in the clopidogrel group was 1.3 per cent compared with 1.1 per cent in the placebo group. CLARITY investigator Tony Gershlick from Glenfield Hospital in Leicester said: “This trial is a major advance in the treatment of acute MI. Clopidogrel brings added efficacy without additional risk. CLARITY will change guidelines and clinical practice so that asprin and clopidogrel become standard antiplatelet therapy.”

The trial included 3,491 men and women aged 75 years or younger. All patients experienced the onset of their heart attack within the 12 hours preceding treatment and received either clopidogrel (300mg loading dose, then 75mg once daily) or placebo up to the time of angiography.

A second study in 45,852 patients presented at the ACC, COMMIT, showed that adding 75mg of clopidogrel daily to aspirin reduced the relative risk of death in hospital by 7 per cent and the risk of death, repeat heart attack or stroke by about 10 per cent without any significant increase in serious bleeds. Principal investigator Zhengming Chan from Oxford’s Clinical Trial Service Unit said: “These benefits were additional to those of standard treatment and were seen even in older patients and those presenting several hours after the onset of symptoms.”